Restoration of Anterior Fractured Tooth

30 Sep 2014 - 8728

In recent years, the advancements in composite materials have made preservation of tooth structure a reality and thus changing the landscape of dentistry to becoming what it is today, more conservative and minimally invasive. Conservative and minimal invasion is always my philosophy of treatment, I believe MICD will become the trend in the future.

 

CASE

Gender: Male

Age: 13 yr

Occupation: Student

Chief Complaint:
Anterior tooth was fractured three days ago.

HPI:
Anterior upper tooth was fractured three days ago, no other symptom. Asking for treatment。

Past Medical history:
No systematic disease or history of drug allergy。

Examination:

11 tooth crown fracture, distal-incisal defection, lingual dentin exposure, no other symptom, OH fair,

Pas radiographic findings: 11 tooth crown fracture, normal periapices.

Diagnosis
11 tooth fracture

Treatment plan:
(1) 11 direct composite restoration

(2) Regular recall

Treatment procedure :

Fig. 1

Initial clinical situation: 11 distal incisal defection.

Fig. 2

Occlusal View.

Fig. 3

Shade selection with Vita Classical shade guide (A1, A2).

Fig. 4

Total etching with phosphoric acid, enamel etching 30 seconds, dentin etching 15 seconds, the etching area is 0.5-1 mm beyond the bevel margin.

Then apply a universal adhesive in the enamel and dentin (Singlebond 2, 3M ESPE).

Fig. 5

Build up the palatal enamel layer with 3M Filtek Z350XT with a silicon key.

Fig. 6

Dentin application with 3M Filtek Z350XT A2D.

Fig. 7

Enamel application with 3M Filtek Z350XT A2E.

Fig. 8

Create the vestibular anatomy and texture, lines. Then finishing and polishing.

Fig. 9

Immediate result after polishing.

Fig. 10

Immediate result after polishing.

Fig. 11

Refine the texture two weeks later.

Fig. 12

Lateral view, reproduce the natural anatomy and texture perfectly.

Fig. 13

Recall situation, 4 weeks later.

Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

X-ray at the 4-weeks later recall, normal periapices.

Fig. 19

Polar eyes.

 

Conclusions

Tip and Tricks

1. Good communication with patient is the basic of a successful treatment

2. Shade selection is the first step to esthetic restoration. The time and light source is the key point during shade selection. Wax up helps a lot during the patient smile analysis and treatment planning.

3. Standard operation protocol. Pay attention in each step of the adhesive procedure.

4. Choose of right composite material, using composite multi-layering technique. Finishing and polishing will define the final result; remember to reproduce the natural anatomy and texture.

5. Periodical recall,  good OH situation help maintain the long-lasting result.

Bibliography